- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,311.31 / $9,120.11
| Facility | | $602.56 | $3,311.31 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,888.44 / $13,489.63
| Facility | | $2,238.72 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,230.27 / $3,467.37
| Facility | | $588.84 | $1,230.27 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | 22 | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,981.07 / $10,000.00
| Facility | | $1,047.13 | $3,981.07 | $10,000.00 |